Spinal cord injury rehabilitation begins in the acute care unit and continues through discharge from the rehabilitation hospital and reintegration back to the community. The goal of rehabilitation is to facilitate the medical and neurologic recovery and help patients maximize their functional recovery from a disabling injury.
The rehabilitation process begins when patients with a new spinal cord injury are evaluated by a consulting physiatrist, a physician specializing in physical and rehabilitation medicine.
Once patients are medically stable, they are transferred to a rehabilitation hospital, such as the Rehabilitation Institute of Chicago. Under the direction of a physiatrist, patients are cared for by a rehabilitation team comprised of the following professionals:
- Physical therapists
- Occupational therapists
- Speech language pathologists
- Rehabilitation nurses
- Social workers
The site of rehabilitation activities is not limited to a single area or location. Therapy may occur at the bedside for those with significant medical complications. Most therapeutic interventions occur on the inpatient floor, where the interdisciplinary team can work with nursing staff to provide therapy services while attending to complex, specialized nursing and medical issues. As recovery progresses, advanced therapies may take place in other specialized areas of the facility.
The therapeutic disciplines and programs described are all focused on the needs and goals of the individual patients, with particular attention being paid to their home and work and/or school environments. Patients are urged and expected to take an active role in the development and course of their rehabilitation program.
Key components of a spinal cord injury rehabilitation program:
Spinal Cord Medicine
The care of each spinal cord-injured patient may be directed by a physiatrist, a physician with specialization and board-certification in physical medicine and rehabilitation and possibly a subspecialty certification in Spinal Cord Medicine. Upon admission to the rehabilitation program and throughout the rehabilitation hospitalization, patients undergo continual monitoring and evaluation of their injury which may include:
- Radiographic follow-up of their spine injury
- Regular assessment of their medical and neurologic status
- Management of any active medical issues and secondary issues related to their spinal cord injury including:
- Neurogenic bowel and bladder
- Pressure ulcers
- Autonomic nervous system conditions
- Sexual functioning
In addition to providing appropriate and necessary nursing and medical care, rehabilitation nurses help patients with new spinal cord injuries and their families adapt to their disabilities and provide support and education to understand their care needs. Rehabilitation nurses work with patients to help them achieve their greatest potential and work towards productive, independent lives. Nurses also empower patients when they return home, to work or to school.
Occupational therapy emphasizes the use of functional, purposeful activity to maximize independence after a spinal cord injury. A treatment plan is established based on the patient's functional status, focusing on a variety of areas, such as:
- Self care
- Assistive technology
- Arm and hand strengthening and coordination
- Directing one's care
- Vocational and community skills
Occupational therapists work with patients in individual and group settings to improve their functional independence as they prepare to transition back in the community.
Physical therapy focuses on functional mobility, balance, strengthening, family education and equipment assessment. Based on a patient's level of injury, a plan of care is established to address activities such as:
- Getting in and out of bed
- Transferring from various surfaces
- Gait training
- Directing a caregiver
- Propelling or driving a wheelchair
At Northwestern Memorial, physical therapists work with patients individually or in groups throughout the hospital to achieve goals. With all activities, patients are working towards being active participants in society.
Speech-Language Pathology/Communicative Disorders Therapy
The speech-language pathology/communicative disorders therapist provides speech and language services and frequently assesses, identifies and provides therapy for the following issues:
- Swallowing difficulties—a problem commonly seen in patients with spinal cord injuries
- Alternative communicative systems for patients with tracheostomies who are unable to speak or write due to upper extremity paralysis
- Speech and language function
- Auditory (hearing) function
- Problems associated with coexisting head injury
- Communicative deficits
- Cognitive-related language problems
The psychologist evaluates each patient's emotional response to disability and cognitive deficits (intellectual impairment) that may be present as a result of the injury. After evaluation, the psychologist will provide treatment and counseling to patients and their families.
Social Work/Rehabilitation Care Management
- Supporting and enhancing psychosocial functioning
- Educating and linking patients to community resources and entitlements
- Educating families about spinal cord injury
- Discharge planning
- Transitioning to the community
Therapeutic recreation contributes to the rehabilitation process by improving and maintaining physical, cognitive, emotional and social functioning. Utilizing leisure interests or hobbies as treatment and adapting these activities to enable participation, patients are able to achieve their functional goals, enhance their independence and improve their overall quality of life.
If available, a vocational rehabilitation department may provide a wide range of vocational services to assist patients with return to school, job preparation and employment.